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SECTION 00415 — RESPONSIBLE CONTRACTOR — PROPOSAL ATTACHMENT <br />Page 1 of 2 <br />INITIAL CONTRACTOR VERIFICATION OF COMPLIANCE <br />By signing this document I certify that I am an owner or officer of the company, and I swear under oath that: <br />My company meets each of the minimum criteria in subclauses (1) — (6) of Minn. Stat. § 16C.285, subd. 3, the <br />Responsible Contractor statute. <br />The undersigned understands that a failure to meet or verify compliance with the minimum criteria established for <br />a "responsible contractor" as defined in Minn. Stat. § 16C.285, subd. 3, renders a bidder ineligible to be awarded a <br />construction contract for the Project or to perform work on the Project. <br />The undersigned understands that a false statement under oath verifying compliance with any of the minimum <br />criteria shall make the undersigned, ineligible to be awarded a construction project and may result in termination <br />of a contract awarded to the undersigned. A contracting authority shall not be liable for declining to award a <br />contract or terminating a contract based on a reasonable determination that the contractor failed to verify <br />compliance with the minimum criteria or falsely stated that it meets the minimum criteria. <br />The undersigned understands that, if the undersigned is the apparent low bidder, the undersigned will be required <br />to submit a supplemental verification under oath as a condition precedent to the execution of the contract. If the <br />undersigned fails to provide the required supplemental verification, it could forfeit its bid bond. <br />I have attached a list of all of my company's first -tier subcontractors that I intend to retain for work on the project. <br />Initial Contractor Verification of Compliance - 2017 Puma Street Utility Improvements <br />Authorized Signature of Owner or Offices!/ Printed Name: <br />Title: <br />President <br />Company Name: <br />Killmer Electric Co, Inc. <br />City of Ramsey - R13.113601 <br />Brian Palmer <br />Date: <br />October 27th, 2017 <br />RESPONSIBLE CONTRACTOR — PROPOSAL ATTACHMENT <br />October 2017 PAGE 00415-1 <br />V030215 t0 Bolton & Menk, Inc. 2017, All Rights Reserved <br />